In consideration of allowing my child(ren) to participate in Vacation Bible School I, the parent or guardian of said child(ren), in full recognition and appreciation of the dangers and risks inherent in such activities, do hereby waive, release, and forever discharge the First Free Will Baptist Church of Titusville, its officers, agents and employees from and against any and all claims, demands, action or causes of action for costs, expenses or damages to personal property or personal injury, or death, which may result from my child’s participation in this event.
I, the parent or guardian of said child(ren), do hereby authorize any x-ray examination, anesthetic, dental, medical, or surgical diagnosis or treatment by any physician or dentist licensed by the state and hospital service that may be rendered to the said minor under the general, specific or special consent of the First Free Will Baptist Church of Titusville, Florida, the temporary custodian of the minor. I fully accept all responsibility for my children’s safety.
Please state where your family currently attends church. If you do not have a home church or do not regularly attend church, just write "none" in the required field.